A Systematic Review and Meta-Analysis of Laser Auriculotherapy for Musculoskeletal Pain Management: An Assessment of Its Efficacy

Introduction: Musculoskeletal pain (MSP) is prevalent and a major cause of disability, highlighting the need for nonpharmacologic treatments. Low-level laser therapy auriculotherapy (LLLT-AT) is emerging as a promising noninvasive approach for MSP management. Objective: This systematic review aimed to evaluate the effects of LLLT-AT on MSP patients. Method: A comprehensive electronic search of PubMed, Web of Science, Scopus, Cochrane Library, CINAHL, ScienceDirect, PEDro, and Google Scholar (updated on May 3, 2025) identified randomized clinical trials (RCTs) comparing LLLT-AT with sham, no intervention, or other therapies. Pain intensity was the primary outcome, and disability and pain pressure threshold were secondary. Methodological quality was assessed using the PEDro scale. The risk of bias among the included RCTs was assessed using the Cochrane Risk of Bias 2.0 (RoB 2) tool, and the meta-analysis was performed using the mean difference (MD) or standardized mean difference (SMD), as appropriate. The Grading of Recommendation, Assessment, Development, and Evaluation framework guided evidence certainty. Results: Five RCTs were included, with a mean PEDro score of 7 (standard deviation [SD] 0.7). According to Domain 6 of the RoB 2 tool, 80% of trials demonstrated a low overall risk of bias, with evaluators blinding being the primary concern. LLLT-AT significantly reduced pain intensity post-treatment compared with placebo (SMD = 1.31; 95% confidence interval [CI]: 0.40-2.30; p < 0.01) and no treatment (SMD = 1.12; 95% CI: 0.00-2.20; p < 0.01), reflecting a large effect size. An increase in the pressure pain threshold was also observed (MD = 0.64; 95% CI: 0.00-1.30; p < 0.01), although this result was limited by small sample sizes. However, the certainty of the evidence was judged as very low—deemed critical for pain intensity outcomes and not important for pressure pain threshold. No adverse events were reported. Conclusion: LLLT-AT shows potential for effectively managing MSP, reducing pain intensity, and improving pressure pain threshold. However, further research is needed to strengthen the evidence base due to the limited number of studies and to explore its applicability to other conditions. Dosage recommendations were provided to inform future research and clinical practice.